HomeMy WebLinkAbout08010006 Application.. 1ti? aF Cqq /
City of Ca77tte1 /Clay Township Permit #: l?rJ^1
RESIDENTIAL IMPROVEMENT LOCATION PERMIT APPLICATION
"Ow. For Single Family, Town Home, & Two Family: New Structures, Additions, Remodels, & Accessory Structures
BUILDER NAME: ,_Tr -. PHONE: FAX:
OF
RECORD: ET ADDRESS: CITY:
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) ZIP: _
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,Ac 3-41 Ir
HUiLDER'S EMAIL ADDRESS:
OD OF CONTACT:
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PROPERTY NAME: PHO FRX:
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OWNER; -;cwt sus 4 ,! '
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STREET ADDRESS: +i' ?n 5T ZIP:
LOCATION LOTS: SUBDIVISION NAME: SEG77ON: ZONIN G:
& PROJECT
INFO: ADDRESS OF CONSTRUCTION: SQUARE
FOOTA GE:
SEWER UTILITY
PROVIDER: WATER UTILITY
PROVIDER: ESTIMATED COST OF CONSTRUCTIO
(EXCLUDING LAND VALUE) ' r
... .
NAME OF UTILITY EXCAVATION CONTRACTOR; PLAN COMMISSION / BZA } BPW DOCIFT
NUMBERS; TAC DATE(S); AND/OR COUNTY WELL AND/OR SEPTIC PERMIT #'S (IF APPLICABLE): PT
FLOOD ZONE AREA DESIGNATION(S) y1? I (X-F, TAX MAP PARCEL
FOR THIS PROPERTY:
II -?? -zt?
TYPE F CONSTRUCTION:
SINGLE FAMILY
D TOWN HOME
C TWO FAMILY
# of units being
constructed at this
time:
0 RESIDENTIAL (For
Additions, Remodels. Etc.)
Early Release
Permit: Y _,/ N
Lot Split: ?Y N
For Single Family
TYPE OF IMPROVEMENT:
NEW STRUCTURE
D ROOM ADDITION(S)
O PORCH ADDITION(S)
O DECKADDITION(S)
0 REMODEL
_ Basement finish only
C ACCESSORY BUILDING
a DETACHED GARAGE
ATTACHED GARAGE
DEMOLITION
Manufactured
Trusses: Y _N
Sump Pump: f Y-N
PLUMBING CONTRACTOR:
P', L, -'-f -T E "7 --5
Plumber's Indiana Stare License }
Which plumbing cDde!5 will be applied to the construction:
? International Residential Code w/Indiana Amendments
12<Uniform Plumbing Code w/Indiana Amendments
FOUNDATION TYPE: (Check all that apply for the new
construction area)
? CRAWLSPACE? BEAM -PIER
CD SLAB JX tM ALKOUT:=Y ,/ / N )
structure permits are subject to the General Administr aanv Rules of the State
completing cqp? ?,
289) and amendrx?ents, adopted under authotiry of I.C. 36.7 et seq, General Assembly of ?.
signature of Owner or Autlgrizetl Agent Print
*******************»******************?
OFFICE USE ONLY:
?na tirYra th - Wuance date, Class I
a
4`
Reviewed/Appr ved: Dept. of Community Services (Date)
5:PerrTNt rmS/] ESIDENTIAt.
!, the undersigned, agree chat any canstructian, reconstruction, enlargement, relocaor a_
requested by this application will comply with, and conform to, all applicable laws 0--'the sit
Idtchen, bath, and Floor drains are connected to the sanitary sewer I further certify, tthat;lpa
Orcupancphas been issued by the Department of Community Services, Carmel, I
SPECTIONS REQUIRED:
Upper Footin wen Doting .t
RoLgh In eter Base Final Site
i41 names for beginning and
AI-ige in the use of land or stnxtures
,4P.-dirance of Cannel Indiana -1993' (Z-
,,V& rdatoty thereto. I further certify that only
used or occupied until a CerrE&are of
t
se Inspections: 7.50 # Charged Re-
Cert. of Occupancy 5c? `1 ir" Reviews
p,R.I,F.: (01 00 Additional Fees